Ahmad I, Akhtar S, Rashidi E, Khurram M F
MCh(Plast Surg), Associate Professor, Post-Graduate Department of Burns, Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, India.
J Wound Care. 2013 Nov;22(11):635, 638-40, 642. doi: 10.12968/jowc.2013.22.11.635.
To evaluate the efficacy of soleus muscle flap for covering complex defects of the middle and lower leg. The study also outlines functional gain after the reconstructive procedure, the donor site morbidity and the technical details of the operative procedure.
This prospective study consists of a total of 40 patients with middle and lower third defects with exposed bone present in the leg. In all cases, a proximally-based hemisoleus flap was used. All patients were between 15-65 years of age. Depending upon the position of the defect and ease of rotation, either the medial or lateral hemisoleus was used to cover the defects. In 7 patients with large defects, both the hemi-gastrocnemius and hemisoleus flap were used.
Most of the patients studied (52.5%) had defects in the middle third of their leg. A further 12(30%) patients had defects over the upper part of the lower third of the leg and 7(17.5%) cases involved large defects exposing bones comprising both the middle and lower thirds of the leg. All the flaps survived well except 5 which developed partial skin graft loss, and 1 where complete flap loss was observed. Out of 5 patients who developed partial graft loss, 3 patients achieved complete healing by regular dressings and 2 required regrafting. The patient who developed complete flap loss required below knee amputation. No donor site morbidity was observed, except minimal depression in the posterior leg.
Due to a high degree of reliability, versatility, minimal donor site morbidity, less operating time, low cost and good functional gain, this procedure is highly suitable for the treatment of complex middle and lower leg defects.
There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
评估比目鱼肌瓣修复小腿中下段复杂缺损的疗效。本研究还概述了重建手术后的功能恢复情况、供区并发症以及手术操作的技术细节。
本前瞻性研究共纳入40例小腿中下段缺损且伴有骨质外露的患者。所有病例均采用近端蒂半比目鱼肌瓣。所有患者年龄在15 - 65岁之间。根据缺损位置和旋转便利性，选用内侧或外侧半比目鱼肌瓣修复缺损。7例大缺损患者采用半腓肠肌瓣和半比目鱼肌瓣联合修复。
大部分研究患者（52.5%）小腿中段有缺损。另有12例（30%）患者小腿下段上1/3有缺损，7例（17.5%）患者为累及小腿中下段的大缺损且骨质外露。除5例部分皮片坏死、1例皮瓣完全坏死外，其余皮瓣均成活良好。5例部分皮片坏死患者中，3例经定期换药完全愈合，2例需再次植皮。皮瓣完全坏死的患者行膝下截肢。除小腿后方轻度凹陷外，未观察到供区并发症。
由于该手术具有高度可靠性、多功能性、供区并发症少、手术时间短、成本低及功能恢复良好等优点，非常适合治疗小腿中下段复杂缺损。
本研究无外部资金来源。作者声明无利益冲突。
